LAMINOPLASTY

What’s a Laminoplasty?

The medical term “Laminoplasty” refers to a type of surgery that surgeons usually perform as an alternative to cervical laminectomy (Zhou, Sun, Zhang, Dang, & Liu, 2016). Neurosurgeons perform this procedure to treat cervical myelopathy. Laminoplasty refers to a procedure that reconstructs the vertebral lamina in order to relieve pressure on the spinal cord. The term “Laminoplasty” means “to make a hinge that elevates the lamina”. Neurosurgeons perform this operation only on the vertebrae in the neck (cervical spine) to create a hinge on the lamina, which opens up the area within the spinal canal. Metal hardware spans the gap in the spine’s opening part.

Laminoplasty, unlike laminectomy, retains spinal stability by not removing the lamina. This may reduce the need for additional spine stabilization surgeries in the future. This also aids in the maintenance of spinal movement. The Laminoplasty method involves cutting the lamina on both sides of the affected vertebrae (cutting completely through on one side and just cutting a groove on the other) and then “swinging” the released flap of bone open to relieve pressure on the spinal cord. To allow the lamina bone flap to open, neurosurgeons can remove the spinous process. Later, the neurosurgeon opens the bone flap with little wedges or bone pieces to keep the expanded spinal canal in place. The success of laminoplasty measures in 2 ways: the prevention of neurological deterioration and the improvement of neurological symptoms. According to scientific studies, up to 60% of patients show improvement (Weinberg & Rhee, 2020).

Types of Laminoplasty

The term “single-level laminoplasty” refers to surgery that involves only one vertebra, while multilevel includes more than one vertebra. Different types of laminoplasty may include:

• Cervical laminoplasty: This refers to the hinging of the lamina in the neck (cervical spine).  
• Lumbar laminoplasty: This involves hinging of the lamina in the lower back (lumbar spine).
• Sacral laminoplasty: This includes hinging of the lamina in the back or hip (sacral spine).
• Thoracic laminoplasty: This comprises hinging of the lamina at the middle of the back (thoracic spine).

Conditions for a Laminoplasty

The major goal of a laminoplasty includes relieving patients’ symptoms such as numbness, pain, or weakness in their arms. Patients may also have difficulties moving their hands and fingers, as well as maintaining balance and walking. This surgical treatment helps to relieve pressure on the spinal cord in the neck, which can occur for a variety of reasons, such as tumors, fractures, arthritis, bone spurs, disc herniations, degenerative issues, etc. Neurosurgeons also recommend a laminoplasty for persistent spinal conditions such as spinal stenosis, bone spurs, ankylosing spondylitis, ossified posterior longitudinal ligament (OPLL), etc. 

Risks of a Laminoplasty

Nerve damage to the nerve roots or the spinal cord can occur due to of this surgical treatment, resulting in limb weakness or paralysis, respectively. Other possible complications of laminoplasty include infection, spinal fluid leak, excessive bleeding, failed compression relief, etc. Studies reported some high-risk factors such as old age, poor BMI, smoking status, duration of symptoms, etc. that contribute to perioperative complications of laminoplasty (Hirabayashi & Matsushita, 2011).

How Should Patients Prepare for a Laminoplasty?

Patients need to share all of their medical histories with the neurosurgeon during brief medical examinations. Neurosurgeons suggest that patients avoid smoking as soon as possible, which may delay the healing procedure. Neurosurgeons also advise that patients should avoid aspirin, ibuprofen, and blood thinners a few days before surgery.

How Does a Spinal Surgeon Perform a Laminoplasty?

Neurosurgeons perform a laminoplasty in a hospital or surgical center under general anesthesia. The procedure usually takes between two and five hours to complete. Neurosurgeons will widen your spinal canal by creating a hinge-typemovement in the lamina, the back part of the vertebra. This relieves pressure in your spinal canal or on your spinal nerves on your neck or back. Laminoplasty involves the following techniques (Oshima, Miyoshi, Mikami, Nakamoto, & Tanaka, 2015):

1.     French door or double door laminoplasty: This refers to the hinging of the lamina on both sides with an opening in the middle. Neurosurgeons will place a spacer to bridge the opening or hold the lamina open with a wire.
2.     Open door or single door laminoplasty: This involves hinging of the lamina on one side somewhat as a single door. Neurosurgeons will place a spacer to keep the lamina open somewhat as a doorstop. 
3.     Z-plasty laminoplasty: This complicated surgical procedure involves thinning the lamina and making a Z cut through it. Neurosurgeons will separate the lamina and hold it open with a wire. 

What’s expected from a Laminoplasty recovery?

After a laminoplasty, patients need to stay up to 4 days in the hospital to enhance the recovery process (Zhou et al., 2016). After discharging, patients can resume most activities in 4 to 6 weeks, while total recovery can take anywhere from 6 to 12 weeks. Following the surgery, patients can’t drive for approximately two weeks. For more information, please contact us.

References

Hirabayashi, S., & Matsushita, T. (2011). Two Types of Laminoplasty for Cervical Spondylotic Myelopathy at Multiple Levels. ISRN Orthopedics, 2011, 1–7. https://doi.org/10.5402/2011/637185

Oshima, Y., Miyoshi, K., Mikami, Y., Nakamoto, H., & Tanaka, S. (2015). Long-term outcomes of cervical laminoplasty in the elderly. BioMed Research International, 2015. https://doi.org/10.1155/2015/713952

Steinmetz, M. P., & Resnick, D. K. (2006). Cervical laminoplasty. Spine Journal, 6(6 SUPPL.), 274–281. https://doi.org/10.1016/j.spinee.2006.04.023

Weinberg, D. S., & Rhee, J. M. (2020). Cervical laminoplasty: Indication, technique, complications. Journal of Spine Surgery, 6(1), 290–301. https://doi.org/10.21037/jss.2020.01.05

Zhou, H., Sun, Y., Zhang, F., Dang, G., & Liu, Z. (2016). Clinical case report of expansive laminoplasty for cervical myelopathy due to both disc herniation and developmental cervical spinal canal stenosis in older adolescents. Medicine (United States), 95(8), 1–5. https://doi.org/10.1097/MD.0000000000002879